Intracavitary brachytherapy, for the treatment of cervical cancer can be used effectively

to deliver high rates of radiation to the tumor with high rates of fall off radiation to the
surrounding normal structures. Many complex systems have been developed over the past 5
decades in order to distribute the desired dose of radiation to the tumor volume. Although these
systems were created before the implementation of computer calculations, they are still utilized
today for the purposes of pre-planning. Of all the systems that were developed, the Manchester
system, also known as the Paterson-Parker system is the commonly used system and will be the
subject of this discussion.1
The Manchester system utilizes 4 points which include A and B points, a bladder and a
rectum point for planning purposes. In traditional Manchester dosing, point A which is the
prescription point, lines up 2 cm superior to the head of the ovoids and 2 cm lateral from the
cervical canal.2 Point B is determined from 2 cm superior to the head of the ovoids and 5 cm
lateral from the cervical canal (Figure 1). In 1953 practitioners realized the points needed to be
modified so the prescription could be well defined in relation to anatomical structures.3 In the
revised system, point A is carried with the uterus and is 2cm superior to the lower end of the
tandem along the tandem and 2cm lateral to central canal.2,3 The revised point B remains a fixed
point not necessarily dependent on the uterus 2cm superior to the external cervical os and 5cm
lateral along the body plane (Figure 2).
Although the Manchester system has been a trusted system for decades, one of the
drawbacks with the system is that when using the traditional Manchester method, point A is very
dependent on the placement of the ovoid structures. If the ovoid structures are not placed
properly, point A will be shifted, giving inaccurate calculations.2 Another disadvantage is that
depending on the size of the cervix, Manchester risks overdosing a small tumor and under-dosing
a large tumor.
 References
1. Khan FM, Gibbons JP. The Physics of Radiation Therapy. 5th ed. Philadelphia, PA: Lippincott
Williams and Wilkins. 2014.
2. Lenards N, Berner P, Schmidt K. Intracavity Brachytherapy Dose Specifications. [Softchalk].
La Crosse, WI: UW-L Medical Dosimetry Program; 2016.
3. Sharma A. Manchester System for Gynecological Applications. AAPM website.
https://www.aapm.org/meetings/05SS/program/MANCHESTER_SYSTEM_FOR_GYNECO
LOGICAL_APPLICATIONS_sharma.pdf. Accessed July 29, 2017.
 Figures
Figure 1: Diagram of traditional points A and B for Manchester dosing of cervical cancer3

Figure 2: Revised Manchester system points A and B for dosing of cervical cancer3